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Impact of exercise training after bariatric surgery on cardiometabolic risk factors: a systematic review and meta-analysis of controlled trials

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Abstract

The purpose of this systematic review was to provide updated evidence synthesis of the effectiveness of exercise training in patients with obesity undergoing bariatric surgery to improve cardio-metabolic risk. We systematically searched the MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science databases. The studies selected were those in which an exercise-based intervention was performed after bariatric surgery, a control group was present, and at least one of the following outcomes was investigated: VO2max or VO2peak, resting heart rate (RHR), blood pressure, lipid profile, glucose, and insulin. The study quality was assessed using the PEDro scale and the data were meta-analyzed with a random effects model, comparing control groups to intervention groups using standardized measurements. Twenty articles were included in the systematic review and fourteen (70%) in the meta-analysis. Significant differences were observed between the control and intervention groups (always in favor of exercise) for absolute VO2max / VO2peak (ES = 0.317; 95% CI = 0.065, 0.569; p = 0.014), VO2max / peak relative to body weight (ES = 0.673; 95% CI = 0.287, 1.060; p = 0.001), HDL cholesterol (ES = 0.22; 95% CI = 0.009, 0.430; p = 0.041) and RHR (ES = -0.438; 95% CI = -0.753, -0.022; p = 0.007). No effects were observed for either systolic or diastolic blood pressure. Exercise training for patients undergoing bariatric surgery appears to be effective in improving absolute and relative VO2max / VO2peak, HDL cholesterol and reducing the RHR. More intervention studies using (better) exercise interventions are needed before discarding their effects on other cardiometabolic risk factors. This systematic review and meta-analysis has been registered in Prospero (CRD42020153398).

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Data Availability

Data exchange is not applicable since no databases were generated during the present study.

Code availability

Comprehensive Meta Analysis V2.0.

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Funding

This work was funded by the Spanish Ministry of Economy and Competitiveness (MINECO), Plan Nacional de I + D + i call RETOS 2016 (grant number DEP2016‐74926‐R) and the Spanish Ministry of Science, Innovation and Universities, Plan Nacional de I + D + i call RETOS 2018 (grant number RTI2018-093302-A-I00). EM-R was supported by the Spanish Ministry of Science, Innovation and Universities (FPU18/01107).

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Authors and Affiliations

  1. Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain

    Alejandro Carretero-Ruiz, Elena Martínez-Rosales, Alberto Soriano-Maldonado & Enrique G. Artero

  2. SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain

    Alejandro Carretero-Ruiz, Elena Martínez-Rosales, Alberto Soriano-Maldonado & Enrique G. Artero

  3. Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain

    Iván Cavero-Redondo & Celia Álvarez-Bueno

  4. Universidad Politécnica Y Artística Del Paraguay, Asunción, Paraguay

    Iván Cavero-Redondo, Celia Álvarez-Bueno & Vicente Martínez-Vizcaíno

  5. Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile

    Vicente Martínez-Vizcaíno

  6. Unit of Cardiology, Torrecárdenas University Hospital Almería, Almería, Spain

    Carlos Gómez Navarro & Raúl Reyes Parrilla

  7. General and Bariatric Surgery Unit, Torrecárdenas University Hospital, Almería, Spain

    Manuel Ferrer-Márquez

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  1. Alejandro Carretero-Ruiz
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Contributions

ACR, IC-R, CA-B and EGA designed the review and meta-analysis. ACR and EMR conducted the review and carried out the meta-analysis. ACR wrote the article with the support of EGA, VM-V, MF-M, and AS-M, while EGA provided clinical and epidemiological support. EGA was the principal investigator and guarantor. All authors reviewed and approved the final version of the manuscript.

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Correspondence to Alejandro Carretero-Ruiz.

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Carretero-Ruiz, A., Martínez-Rosales, E., Cavero-Redondo, I. et al. Impact of exercise training after bariatric surgery on cardiometabolic risk factors: a systematic review and meta-analysis of controlled trials. Rev Endocr Metab Disord 22, 891–912 (2021). https://doi.org/10.1007/s11154-021-09651-3

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